DODSER DEPARTMENT OF DEFENSE SUICIDE EVENT REPORT - HEALTH.MIL
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DoDSER Department of Defense Suicide Event Report Calendar Year 2019 Annual Report The estimated cost of this report or study for the Department of Defense is approximately $94,000 in Fiscal Years 2020 - 2021. This includes $750 in expenses and $93,000 in DoD labor. Generated on 2021 March 15 RefID: 0-0E15624
Calendar Year 2019 DoDSER Annual Report
If you or anyone you know is experiencing thoughts of suicide, please reach
out for help immediately.
• Call 800-273-8255. If you’re a Service member or Veteran, press 1 to talk to a
qualified Department of Veterans Affairs (VA) responder.
• In Europe, call 00800 1273 8255 or DSN 118
• In Korea, call 0808 555 1188 or DSN 118
• In Afghanistan, call 00 1 800 273 8255 or DSN 111
• Start a confidential online chat session at www.VeteransCrisisLine.net/chat.
• Send a text message to 838255 to connect to a VA responder.
• If you are deaf or hard of hearing, you can connect through chat, text, or
teletypewriter (TTY).
i
The Calendar Year 2019 DoDSER Annual Report
Psychological Health Center of Excellence
Research and Development Directorate
Defense Health Agency
The estimated cost of this report or study for the Department of Defense is approximately $94,000 for the 2020 and
2021 Fiscal Years. This includes $750 in expenses and $93,000 in DoD labor. Generated on 15 March 2021.
RefID: 0-0E15624.
ii
Contents Calendar Year 2019 DoDSER Annual Report
Table of Contents
Table of Contents ........................................................................................................................... iii
Executive Summary ....................................................................................................................... iv
Chapter 1: Introduction .................................................................................................................. 1
Chapter 2: Suicide Mortality Rates ................................................................................................ 3
Chapter 3: DoDSER Summary - Joint Forces ............................................................................. 17
Chapter 4: DoDSER Summary - Active-Component U.S. Air Force.......................................... 36
Chapter 5: DoDSER Summary - Active-Component U.S. Army ................................................ 39
Chapter 6: DoDSER Summary - Active-Component U.S. Marine Corps ................................... 42
Chapter 7: DoDSER Summary - Active-Component U.S. Navy ................................................ 45
Chapter 8: DoDSER Summary - Reserve Component ................................................................ 48
Appendix A: Section 741 NDAA FY20 Reporting Requirements .............................................. 58
Appendix B: Methods - DoDSER Data Processes ...................................................................... 66
Appendix C: Methods - Suicide Mortality Rates ......................................................................... 70
Appendix D: Glossary.................................................................................................................. 76
Appendix E: Acronyms and Initialisms ....................................................................................... 81
Appendix F: List of Tables .......................................................................................................... 82
Appendix G: List of Figures ........................................................................................................ 84
Appendix H: Frequently Asked Questions (FAQs) ..................................................................... 85
iii
EXSUM Calendar Year 2019 DoDSER Annual Report
Executive Summary
The Department of Defense Suicide Event Report (DoDSER) is the official reporting system for
deaths by suicide and suicide attempts among Service members in the U.S. Air Force, Army,
Marine Corps, Navy, and Space Force. The DoDSER Annual Report presents aggregated results
generated from the DoDSER data collected by the Military Services during a specified calendar
year. New for this year, the Calendar Year 2019 (CY19) DoDSER Annual Report also contains
information in response to Section 741 of the National Defense Authorization Act (NDAA) for
Fiscal Year 2020 (FY20), “Reports on Suicide among Members of the Armed Forces and
Suicide Prevention Programs and Activities of the Department of Defense.” Section 741 required
the Secretary of Defense to report on the total number of suicides, attempted suicides, and known
cases of suicidal ideation among service members (including the reserve component) during a
specified year; the number that occurred during the first 180 days of service along with the
associated initial recruit training locations; and the number that occurred during a contingency
operation deployment. The CY19 DoDSER Annual Report meets the requirements of Section
741 as described in Appendix A, “Section 741 NDAA FY20 Reporting Requirements.”
CY19 Suicide Mortality Rates
There were 344 deaths by suicide identified among active-component service members. The
suicide mortality rate was 25.9 deaths per 100,000 population.
The suicide mortality rates for each active-component service were as follows:
• Air Force: 25.1 suicides per 100,000 population
• Army: 29.8 suicides per 100,000 population
• Marine Corps: 25.3 suicides per 100,000 population
• Navy: 21.5 suicides per 100,000 population
• Space Force: 0 suicides per 100,000 population (from establishment of Space
Force on December 20, 2019 through December 31, 2019)
The suicide mortality rates for the Reserve and the National Guard were 18.2 and 20.3 suicides
per 100,000, respectively.
Military Suicide Mortality Rates over Time
For the active-component population, the data indicated a per-year increase in the suicide
mortality rate ratio from CY11 to CY19. The reserve-component population and the National
Guard population showed no interpretable per-year increases in their rate ratios from CY11 to
CY19.
Comparison of Military Suicide Mortality Rates to the U.S. Adult Population
All changes observed in suicide mortality rates for the military populations for CY11-CY18 were
consistent with the increase in the suicide mortality rate for the U.S. adult population over the
same time frame. The comparison only extends through CY18 because CY19 data were not yet
available for the U.S. population.
ivEXSUM Calendar Year 2019 DoDSER Annual Report
DoDSER Active Component Data Summary
• Firearm use was the most common method of injury cited in suicide DoDSER forms,
accounting for 59.9% of all CY19 suicides.
• Drug and/or alcohol overdose was the most common method of attempted suicide cited in
DoDSER forms, accounting for 53.1% of reported CY19 suicide attempts.
• Less than half (43.6%) of those who died by suicide in CY19 had a documented
behavioral health diagnosis.
• Regardless of whether or not an individual voluntarily disclosed – or was assessed for –
suicidal thoughts, feelings, or behaviors, approximately half (52.4%) of all individuals
who died by suicide in CY19 made contact with the Military Health System (MHS) in the
90 days prior to death.
• The prevalence of various risk factors, protective factors, and other suicide event
characteristics among suicide and suicide-attempt DoDSER forms in CY19 were
generally consistent with levels observed for previous years.
DoDSER Reserve Component Data Summary
• Firearm use was the most common method of injury cited in CY19 suicide DoDSER
forms for the Reserve (67.9%) and the National Guard (72.7%).
• Drug and/or alcohol overdose was the most common method of attempted suicide cited in
CY19 DoDSER forms, accounting for 46.6% of reported suicide attempts for the Reserve
and 44.8% of attempts for the National Guard.
vIntroduction Calendar Year 2019 DoDSER Annual Report
Chapter 1: Introduction
The Department of Defense Suicide Event Report (DoDSER) is the official reporting system for
suicide events in the U.S. Air Force, Army, Marine Corps, Navy, and Space Force.1 All cases of
suicide death and suicide attempt among military Service members are to be reported via the
DoDSER.2 The Psychological Health Center of Excellence (PHCoE), a division of the Defense
Health Agency Research and Development (J-9) Directorate, is responsible for the operation of
the DoDSER, which has three primary elements:
1. A web-based system for collecting, organizing, and securing a standard set of case-level
data for every service member who dies by suicide or makes a suicide attempt, regardless
of military service, component, or duty status. The portal for the system is
https://dodser.t2.health.mil/.1
2. A data-collection form that guides trained Military Health System (MHS) or command-
level appointees on the data to assess and collect, as well as potential sources for required
information. The content of the DoDSER form resulted from a collaborative process
between the Military Services, civilian and military experts, senior military leaders, and
key stakeholders. The form is periodically revised to reflect the evolving needs of each
service; it currently contains more than 500 data elements. Table 1 displays the DoDSER
form’s content areas.
Table 1. DoDSER form content areas
Content Area Variables and Types of Variables
Personal Information Age, sex, ethnicity, education, marital status
Military Information Job code, duty status, permanent duty station
Event Information Access to firearms, event method, event setting
Medical History Behavioral health and medical history
Military History Deployment history, disciplinary action
Personal History Developmental and family history, current stressors
Narrative Summary Information on data-collection strategy
3. An annual report of aggregated results generated from the data collected during a given
calendar year. It is the culmination of collaborative efforts between PHCoE, the Suicide
Prevention Program Offices of the Air Force, Army, Marine Corps, and Navy, the
National Guard Bureau, the Defense Suicide Prevention Office, and the Armed Forces
Medical Examiner System (AFMES).
To distinguish between these elements, the words system, form, or annual report appear after the
DoDSER acronym throughout this report.
Interpretation of DoDSER Data
The reader is advised that this annual report’s descriptions of specific risk and contextual factors
must not be interpreted as underlying causes of suicide. It is not possible to determine whether
any variable is a risk factor for suicide solely from the data presented in this report. Identifying
such relationships requires formal research that includes individuals who do not die by suicide or
1Introduction Calendar Year 2019 DoDSER Annual Report engage in a suicide attempt. This type of research is outside the surveillance function of the DoDSER system. The reader should also take into account the content area of any given DoDSER item when interpreting results. While this report reflects the best data available, several items address contextual factors that may not be precisely determined using data from existing databases or from evidence collected following the event. As a result, these types of items include response options of “No Known History” and/or “Cannot Determine.” In this report, these response options are combined with “No” responses to differentiate them from “Yes” responses that indicate the existence of validating data or evidence. See Appendix B for more information about DoDSER data processes. Special Note about the U.S. Space Force The U.S. Space Force was established on December 20, 2019 within the Department of the U.S. Air Force. Given the date of establishment, the Space Force data for CY19 will be discussed in the Air Force chapter of this Report (see Chapter 4). All future DoDSER Annual Reports will have a chapter dedicated to the Space Force. References and Notes 1. For more information on the DoDSER System, see the System of Record Notice (April 15, 2016, 81 FR 22240) at https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN- Article-View/Article/570683/edha-20-dod 2. For more information on suicide death and attempt reporting via the DoDSER system, see DoD Instruction 6490.16, “Defense Suicide Prevention Program,” September 11, 2020 at https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/649016p.pdf?ver=2020- 09-11-122632-850 2
Suicide Mortality Rates Calendar Year 2019 Annual Report
Chapter 2: Suicide Mortality Rates
This chapter first presents a primer on interpreting statistical data, which includes information
about suicide mortality rate comparisons and a statistical measure of uncertainty, the confidence
interval. The chapter then presents suicide mortality rate data for CY19 and the results of trend
analyses of suicide mortality rates from CY11 through CY19. The chapter also presents results
of comparisons between military and U.S. adult population rates for CY11 through CY18. For
detailed information about the calculation of suicide rates, see Appendix C.
A Primer on Interpreting Statistical Data
Annual suicide mortality rates represent the number of deaths by suicide per 100,000 individuals
from a specified population for a specified year. For example, a rate of 20 per 100,000
individuals means that 20 suicide deaths occurred for every 100,000 individuals in the
population.
Suicide mortality rates can be compared 1) between different populations during the same time
period or 2) within the same population over different time periods. Before undertaking any rate
comparison, one must consider whether the populations differed from one another in a way that
could make a comparison misleading. For example, men have a higher suicide mortality rate than
women in the U.S. adult population and the U.S. military population has a higher proportion of
men than women. A direct comparison of the suicide mortality rates between these populations
would show that the U.S. military rate is higher. This rate difference can be attributed, at least in
part, to the unequal proportions of men in each population. Rate standardization is one technique
that can be used to remove important imbalances between populations. Appendix C provides
more detail on how rate standardization can be accomplished.
Suicide mortality rates and comparisons between them are considered estimates. It is not possible
to know the true values of rates or differences between rates. However, the data collected (i.e.,
observed data) provide the best estimate of the difference. The observed data are used to estimate
a confidence interval (CI). A CI defines a range of values that may contain the true value. A 95%
CI is an interval that has a 95% probability of containing the true value. The estimated value
from the data is considered consistent with a true value contained within the interval, including
the endpoints.1
As an example, if the annual suicide mortality rate for population A was 21 per 100,000 for year
X and for population B was 18 per 100,000 for year X, then the corresponding rate ratio is
21/18=1.17. This means that the observed rate for population A was 17% greater than the
observed rate for population B. The 95% CI for this comparison covers all values from 0.96 to
1.42. This means that the estimated ratio of 1.17 is consistent with a true ratio between 0.96 (or
population A’s rate as 4% less than population B’s rate) and 1.42 (or population A’s rate as 42%
greater than population B’s rate). Note that for rate ratios, a value of 1 indicates that there is no
difference between the rates compared (e.g., 21/21=1). Accordingly, when a confidence interval
for a rate ratio covers the value of 1, the observed data are consistent with a true value of 1 (i.e.,
no real difference between the rates).
3Suicide Mortality Rates Calendar Year 2019 Annual Report
CY19 Suicide Mortality Rates by Military Population
Table 2 displays suicide mortality counts and rates by military population for CY19. Tables 3-9
provide suicide mortality counts and rates across demographic categories for each military
population (active component, Reserve, National Guard) and for the active-component
populations of each service. Per DoD policy, suicide mortality rates are not reported for
populations with fewer than 20 events.2
Table 2. Frequency and rate of death by suicide for CY19, by military population
Population No. Ratea
Active 344 25.9
Air Force 83 25.1
Army 142 29.8
Marine Corps 47 25.3
Navy 72 21.5
Reserveb 65 18.2
Air Force 13 --
Army 36 18.9
Marine Corps 9 --
Navy 7 --
National Guardb 89 20.3
Air 15 --
Army 74 22.3
a
Unstandardized rate per 100,000 persons. Rates for subgroups
with fewer than 20 suicides are not reported because of statistical
instability.
b
Rates for the Reserve and the National Guard include all service
members, irrespective of duty status.
4Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 3. Frequency and rate of death by suicide, active component, Air Force, Army, Marine Corps, and Navy combined, CY19,
by demographic characteristics
No. Ratea
Total 344 25.9
Sex
Female 29 12.9
Male 315 28.6
Race
American Indian/Alaska Native 7 --
Asian/Pacific Islander 22 28.6
Black/African American 36 15.9
White/Caucasian 260 28.6
Other/Unknown 19 --
Hispanic ethnicity
Yes 52 23.8
No 277 27.0
Unknown 15 --
Age
17-19 27 25.7
20-24 134 31.0
25-29 92 30.1
30-34 40 19.4
35-39 32 20.8
40-44 16 --
45-49 3 --
50-54 0 --
55-59 0 --
Rank/grade
Cadet/Midshipman 1 --
E1 – E4 170 30.0
E5 – E9 149 28.8
Officer 20 9.4
Warrant officerb 4 --
Education
Some high school 2 --
Alternative high school certification 23 60.2
High school graduate 235 29.5
Some college, no degree 12 --
Associate's degree or technical certification 33 28.0
Four-year college degree 25 13.6
Master's degree or greater 7 --
Unknown 7 --
Marital status
Never married 151 25.6
Married 170 25.3
Legally separated 0 --
Divorced 23 36.7
Widowed 0 --
Unknown 0 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
b
Note: The Air Force does not have the rank of Warrant officer.
5Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 4. Frequency and rate of death by suicide, Reserve, Air Force, Army, Marine Corps, and Navy combined, CY19, by
demographic characteristics
No. Ratea
Total 65 18.2
Sex
Female 3 --
Male 62 22.4
Race
American Indian/Alaska Native 0 --
Asian/Pacific Islander 4 --
Black/African American 8 --
White/Caucasian 50 20.8
Other/Unknown 3 --
Hispanic ethnicity
Yes 3 --
No 55 20.6
Unknown 7 --
Age
17-19 4 --
20-24 16 --
25-29 13 --
30-34 15 --
35-39 6 --
40-44 5 --
45-49 6 --
50-54 0 --
55-59 0 --
Rank/grade
Cadet/Midshipman 0 --
E1 – E4 32 23.2
E5 – E9 21 14.2
Officer 9 --
Warrant officerb 2 --
Unknown 1 --
Education
Some high school 5 --
Alternative high school certification 1 --
High school graduate 37 20.3
Some college, no degree 6 --
Associate's degree or technical certification 3 --
Four-year college degree 8 --
Master's degree or greater 3 --
Unknown 2 --
Marital status
Never married 32 19.4
Married 31 18.7
Legally separated 0 --
Divorced 1 --
Widowed 0 --
Unknown 1 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
b
Note: The Air Force does not have the rank of Warrant officer.
6Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 5. Frequency and rate of death by suicide, National Guard, Air Force and Army combined, CY19, by demographic
characteristics
No. Ratea
Total 89 20.3
Sex
Female 6 --
Male 83 23.3
Race
American Indian/Alaska Native 1 --
Asian/Pacific Islander 2 --
Black/African American 11 --
White/Caucasian 74 21.4
Other/Unknown 1 --
Hispanic ethnicity
Yes 5 --
No 65 16.8
Unknown 19 --
Age
17-19 5 --
20-24 29 28.3
25-29 21 24.6
30-34 15 --
35-39 5 --
40-44 5 --
45-49 5 --
50-54 3 --
55-59 1 --
Rank/grade
Cadet/Midshipman 0 --
E1 – E4 44 22.3
E5 – E9 36 19.8
Officer 7 --
Warrant officerb 2 --
Unknown
Education
Some high school 3 --
Alternative high school certification 10 --
High school graduate 38 21.1
Some college, no degree 14 --
Associate's degree or technical certification 5 --
Four-year college degree 7 --
Master's degree or greater 3 --
Unknown 9 --
Marital status
Never married 49 21.2
Married 33 18.2
Legally separated 0 --
Divorced 7 --
Widowed 0 --
Unknown 0 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
b
Note: The Air Force does not have the rank of Warrant officer.
7Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 6. Frequency and rate of death by suicide, active component, Air Force, CY19, by demographic characteristics
No. Ratea
Total 83 25.1
Sex
Female 10 --
Male 73 27.9
Race
American Indian/Alaska Native 1 --
Asian/Pacific Islander 7 --
Black/African American 5 --
White/Caucasian 60 25.7
Other/Unknown 10 --
Hispanic ethnicity
Yes 14 --
No 66 24.9
Unknown 3 --
Age
17-19 7 --
20-24 28 29.4
25-29 24 29.6
30-34 9 --
35-39 11 --
40-44 4 --
45-49 0 --
50-54 0 --
55-59 0 --
Rank/grade
Cadet/Midshipman 0 --
E1 – E4 36 28.3
E5 – E9 40 29.5
Officer 7 --
Warrant officerb 0 --
Education
Some high school 1 --
Alternative high school certification 0 --
High school graduate 50 29.6
Some college, no degree 0 --
Associate's degree or technical certification 18 --
Four-year college degree 9 --
Master's degree or greater 4 --
Unknown 1 --
Marital status
Never married 35 26.0
Married 37 20.9
Legally separated 0 --
Divorced 11 --
Widowed 0 --
Unknown 0 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
b
Note: The Air Force does not have the rank of Warrant officer.
8Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 7. Frequency and rate of death by suicide, active component, Army, CY19, by demographic characteristics
No. Ratea
Total 142 29.8
Sex
Female 12 --
Male 130 32.2
Race
American Indian/Alaska Native 1 --
Asian/Pacific Islander 8 --
Black/African American 22 21.6
White/Caucasian 110 34.2
Other/Unknown 1 --
Hispanic ethnicity
Yes 16 --
No 126 31.7
Unknown 0 --
Age
17-19 12 --
20-24 59 39.7
25-29 34 30.9
30-34 17 --
35-39 11 --
40-44 7 --
45-49 2 --
50-54 0 --
55-59 0 --
Rank/grade
Cadet/Midshipman 1 --
E1 – E4 77 37.5
E5 – E9 57 32.7
Officer 4 --
Warrant officer 3 --
Education
Some high school 0 --
Alternative high school certification 17 --
High school graduate 93 36.3
Some college, no degree 12 --
Associate's degree or technical certification 8 --
Four-year college degree 9 --
Master's degree or greater 2 --
Unknown 1 --
Marital status
Never married 58 29.2
Married 79 31.3
Legally separated 0 --
Divorced 5 --
Widowed 0 --
Unknown 0 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
9Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 8. Frequency and rate of death by suicide, active component, Marine Corps, CY19, by demographic characteristics
No. Ratea
Total 47 25.3
Sex
Female 2 --
Male 45 26.5
Race
American Indian/Alaska Native 2 --
Asian/Pacific Islander 4 --
Black/African American 1 --
White/Caucasian 38 25.5
Other/Unknown 2 --
Hispanic ethnicity
Yes 9 --
No 38 26.3
Unknown 0 --
Age
17-19 4 --
20-24 24 27.0
25-29 12 --
30-34 3 --
35-39 2 --
40-44 1 --
45-49 1 --
50-54 0 --
55-59 0 --
Rank/grade
Cadet/Midshipman 0 --
E1 – E4 28 25.6
E5 – E9 17 --
Officer 1 --
Warrant officer 1 --
Education
Some high school 1 --
Alternative high school certification 0 --
High school graduate 44 28.5
Some college, no degree 0 --
Associate's degree or technical certification 1 --
Four-year college degree 1 --
Master's degree or greater 0 --
Unknown 0 --
Marital status
Never married 26 24.9
Married 21 27.7
Legally separated 0 --
Divorced 0 --
Widowed 0 --
Unknown 0 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
10Suicide Mortality Rates Calendar Year 2019 Annual Report
Table 9. Frequency and rate of death by suicide, active component, Navy, CY19, by demographic characteristics
No. Ratea
Total 72 21.5
Sex
Female 5 --
Male 67 25.0
Race
American Indian/Alaska Native 3 --
Asian/Pacific Islander 3 --
Black/African American 8 --
White/Caucasian 52 25.3
Other/Unknown 6 --
Hispanic ethnicity
Yes 13 --
No 47 21.3
Unknown 12 --
Age
17-19 4 --
20-24 23 23.1
25-29 22 26.8
30-34 11 --
35-39 8 --
40-44 4 --
45-49 0 --
50-54 0 --
55-59 0 --
Rank/grade
Cadet/Midshipman 0 --
E1 – E4 29 23.4
E5 – E9 35 23.0
Officer 8 --
Warrant officer 0 --
Education
Some high school 0 --
Alternative high school certification 6 --
High school graduate 48 22.0
Some college, no degree 0 --
Associate's degree or technical certification 6 --
Four-year college degree 6 --
Master's degree or greater 1 --
Unknown 5 --
Marital status
Never married 32 20.9
Married 33 19.7
Legally separated 0 --
Divorced 7 --
Widowed 0 --
Unknown 0 --
a
Rate per 100,000 persons. Categories with fewer than 20 events do not have a rate
reported because of statistical instability.
11Suicide Mortality Rates Calendar Year 2019 Annual Report
Suicide Mortality Rates over Time
Longer-Term Trends in Rates
The age- and sex-adjusted annual suicide mortality rates for the active component, Reserve, and
National Guard populations from CY11-CY19 are displayed in Figure 1. Similar graphs for the
active-component population of each of the Military Services are displayed in Figure 2. The
dashed line for each graph is the estimated rate from the linear trend assessment.
Figure 1. Age- and sex-adjusted annual suicide mortality rates for the active component, Reserve, and
National Guard, CY11-CY19. Note: Annual rate estimates are presented as a scatter plot with 95%
CIs. The dashed line is the estimated rate from the linear trend assessment.
12Suicide Mortality Rates Calendar Year 2019 Annual Report
Figure 2. Age- and sex-adjusted annual suicide mortality rates for the active component, by Military
Service, CY11-CY19. Note: Annual rate estimates are presented as a scatter plot with 95% CIs. The
dashed line is the estimated rate from the linear trend assessment.
Table 10 displays the per-year rate ratios and associated 95% CIs from CY11 through CY19 for
each of the populations (see Primer at the beginning of the chapter for an explanation of CIs).
The per-year increases for the total active component population, and the active-component
populations of the Air Force, Marine Corps, and Navy were consistent with true increases. In
contrast, the ratios for the active-component Army population, Reserve, and National Guard
populations were consistent with no true increases.
Table 10. Per-year change in suicide mortality rates, CY11-CY19, by population
Population Per-year ratioa 95% CIb
Active 1.04 1.02, 1.05
Air Force 1.07 1.03, 1.10
Army 1.02 1.00, 1.04
Marine Corps 1.05 1.01, 1.09
Navy 1.05 1.01, 1.08
Reserve 1.02 0.99, 1.05
National Guard 1.00 0.98, 1.03
aPer-year rate ratio adjusted for age and sex. Ratios greater than 1 indicate a per-year
increase in the associated suicide mortality rate.
bThe 95% confidence interval (CI) indicates the range of plausible values for the true
ratio. Note that when a confidence interval for a rate ratio covers the value of 1, the
observed data are consistent with a true value of 1 (i.e., no real difference between the
rates).
13Suicide Mortality Rates Calendar Year 2019 Annual Report
Comparison of U.S. Military Suicide Mortality Rates to the U.S. Adult Population
CY19 suicide mortality data for the U.S. population was not available at the time of this report.
As a result, data analyses did not extend beyond CY18. The U.S. suicide mortality rates from
CY11 to CY18 were restricted to the rates for adults aged 17-59 years and then used for analyses
in this report. The age restriction was needed to make the military and U.S. populations more
comparable. From CY11 through CY18, the U.S. adult population suicide mortality rate
increased 2% per year.3
Figure 3 displays the annual standardized rates for the active component, Reserve, and National
Guard populations. Figure 4 displays similar graphs for the active-component populations of
each of the Military Services.
Figure 3. Age- and sex-standardized annual suicide mortality rates (points and 95% CIs), CY11-CY18,
compared to the U.S. adult (ages 17-59) population suicide mortality rate, by military population.
14Suicide Mortality Rates Calendar Year 2019 Annual Report
Figure 4. Age- and sex-standardized annual suicide mortality rates (points and 95% CIs), CY11-CY19,
compared to the U.S. adult (ages 17-59) population suicide mortality rate, by Military Service.
Table 11 displays the unstandardized and age- and sex-standardized per-year change estimates
for the active component (total and by service), Reserve, and National Guard populations. After
standardization and accounting for the increase over time in the U.S. adult population suicide
mortality rate, the increases in the suicide mortality rates for the military populations from
CY11-CY18 were shown to be consistent with the increase that occurred in the U.S. adult
population rate over the same time frame.
Table 11. Unstandardized and standardized linear trend estimates from CY11-CY18, by military
population
Unstandardized Standardizeda
Population Per-year ratiob 95% CI Per-year ratioc 95% CI
Active 1.03 1.01, 1.05 1.00 0.98, 1.02
Air Force 1.06 1.02, 1.10 1.02 0.98, 1.07
Army 1.01 0.99, 1.04 0.98 0.96, 1.01
Marine Corps 1.05 1.01, 1.10 1.02 0.97, 1.07
Navy 1.04 1.00, 1.08 1.01 0.97, 1.05
Reserve 1.04 1.00, 1.07 1.01 0.98, 1.04
National Guard 1.03 1.00, 1.05 1.00 0.98, 1.07
a
Standardized for age and sex using the CY18 U.S. adult suicide mortality rate (18.4 per 100,000).
b
Adjusted for age and sex differences within each military population over time.
c
Adjusted for age and sex differences within each military population over time and standardized to the U.S. adult
population suicide mortality rates from CY11-CY18.
15Suicide Mortality Rates Calendar Year 2019 Annual Report References and Notes 1. Anderson, A. A. (2019). Assessing statistical results: magnitude, precision, and model uncertainty. The American Statistician, 73(S1): 118-121. Doi: 10.1080/00031305.2019.1537889. 2. For more information on suicide rate reporting, see DoD Instruction 6490.16, “Defense Suicide Prevention Program,” September 11, 2020 at https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/649016p.pdf?ver=2020- 09-11-122632-850. 3. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2018 on CDC WONDER Online Database, released in 2020. Data are from the Multiple Cause of Death Files, 1999-2018, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Mar 27, 2020 16
U.S. Joint Forces Calendar Year 2019 Annual Report
Chapter 3: DoDSER Summary - Joint Forces
Introduction
This chapter presents an overview of the combined Air Force, Army, Marine Corps, and Navy
data for submitted active-component suicide and suicide-attempt DoDSER forms. The data
tables for suicide and suicide attempt cases are presented separately. Data tables are organized by
the following variable categories: demographic and military characteristics (Tables 12 and 13),
suicide event characteristics (Tables 14 and 15), physical and mental health characteristics
(Tables 16 and 17), and psychosocial and adverse experiences (Tables 18 and 19). Data tables
contain joint data as well as data for each of the Military Services. Variables of particular interest
are presented in the text of this chapter and the following four service-specific chapters.
Suicide Mortality
There were 287 active-component suicide deaths confirmed by AFMES for CY19 as of January
31, 2020, all of which required a DoDSER form submission. For inclusion in this report, a
DoDSER form for each event must have been submitted by March 31, 2020. A total of 284 of
the required forms were submitted and three were not. There were an additional 57 events
identified by AFMES as either a confirmed suicide or that were still pending confirmation after
January 31, 2020. No forms were required for submission for these events prior to the cutoff date
for this report; however, any forms submitted were included in the analysis here. We received a
total of 35 of these forms, which brought the total forms available for this report to 319.
Suicide Attempts
Over the course of CY19, DoDSER forms were submitted for 1,462 suicide attempts by 1,388
unique individuals. Note that some individuals made more than one suicide attempt during
CY19.
Occurrence of Previous Suicide Attempt(s) Reported via the DoDSER System
Four active-component CY19 suicides were associated with one or more previously reported
suicide attempt(s) that occurred between CY10 (when attempts were first entered into the
DoDSER system; CY08 for Army) and CY19.
Thirty-three individuals with a submitted CY19 suicide-attempt DoDSER form had one or more
previous suicide attempt(s) recorded in the DoDSER system since CY10 (CY08 for Army). The
median number of days between the first reported suicide attempt in CY19 and the most recent
attempt prior to CY19 was 226 days.
Demographic Characteristics
Demographic characteristics are presented in Tables 12 and 13. The demographic profiles for
both suicide and suicide-attempt DoDSER forms were consistent between CY19 and the
averages for CY16-CY18. Note that the three-year averages for CY16-CY18 were used to
provide more stable statistical comparisons.
17U.S. Joint Forces Calendar Year 2019 Annual Report Method of Injury Firearm use was the most common (59.9%) method of injury identified in suicide DoDSER forms. This was consistent with the average percentage for CY16-CY18. The majority (87.4%) of the firearms used were personal possessions. Relatively few firearm deaths (9.9%) resulted from the self-directed use of a military-issued firearm. For suicide-attempt DoDSER forms, drug and/or alcohol overdose was the most frequently reported method of injury (53.0%). This indicated a 6.1% reduction (95% CI = -11.3%, -0.6%) in attempts attributable to drug and/or alcohol overdose relative to the average for CY16-CY18. Behavioral Health History Among suicide DoDSER forms, 43.6% had at least one current or past behavioral health diagnosis in their medical record. Substance use disorders (20.7%) and adjustment and mood disorders (17.9% each) were the most common diagnostic categories. Among suicide-attempt DoDSER forms, 57.3% had at least one current or past behavioral health diagnosis in their medical record. Mood disorders (29.7%), substance use disorders (21.6%), and anxiety disorders (21.5%) were the most common diagnostic categories. Figure 5 displays the prevalence of mental health diagnoses, prior self-harm, and the use of psychotropic medication in the 90 days prior to a suicidal behavior among active-component DoDSER forms submitted for CY19 and the three-year average for CY16-CY18. The prevalence estimates from CY19 suicide and suicide-attempt DoDSER forms were largely consistent with the average estimates for CY16-CY18. For suicide-attempt DoDSER forms, there was a 13.1% reduction (95% CI = -21.5%, -3.7%) in the prevalence of recent psychotropic medication usage relative to the average for CY16-CY18. Figure 5. Percentages of active-component DoDSER forms that indicated selected mental health factors, by event type, CY16-CY19. Blue bars represent CY19 data, black bars are the three-year averages for CY16-CY18, and the whiskers are the half-width of the 95% confidence intervals. Health Care Utilization Regardless of whether or not an individual voluntarily disclosed – or was assessed for – suicidal thoughts, feelings, or behaviors, 52.4% of the Service members who died by suicide in CY19 18
U.S. Joint Forces Calendar Year 2019 Annual Report had been in contact with the MHS in the 90 days prior to death. The most common type of appointment was a general visit to a medical treatment facility (45.8%) and the second most common type was a mental health visit (32.0%). Outpatient mental health services were utilized in 31.3% of cases while inpatient mental health services were utilized in 6.3% of cases. For reported suicide attempts, 61.7% of the DoDSER forms indicated contact with the MHS in the 90 days prior to the behavior. The most common types of appointments were general visits to a medical treatment facility (50.4%) and mental health visits (47.2%). Outpatient mental health services were utilized in 45.1% of cases while inpatient mental health services were utilized in 14.7% of cases. Stressors Among suicide DoDSER forms, relationship (42.6%), legal/administrative (28.5%), and work (13.8%) stressors within 90 days of the event were the most common stressors identified in CY19 (Figure 6). Similarly, among suicide-attempt DoDSER forms, relationship (36.7%), legal/administrative (28.7%), and work (35.0%) stressors were the most common stressors identified in CY19 (Figure 6). The prevalence estimates from CY19 suicide and suicide-attempt DoDSER forms were largely consistent with the average estimates for CY16-CY18. For suicide DoDSER forms, there was a 31.8% reduction (95% CI = -49.6%, -7.5%) in the prevalence of work stressors relative to the average for CY16-CY18. Figure 6. Percentages of active-component DoDSER forms that indicated selected contextual stressors within 90 days of the event, by event type, CY16-CY19. Blue bars represent CY19 data, black bars are the three-year averages for CY16-CY18, and the whiskers are the half-width of the 95% confidence intervals. 19
U.S. Joint Forces Calendar Year 2019 Annual Report
Table 12. Demographic characteristics, active-component suicide DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Sex
Male 292 91.5 65 87.8 119 91.5 43 95.6 65 92.9
Female 27 8.5 9 12.2 11 8.5 2 4.4 5 7.1
Age
17-19 23 7.2 5 6.8 11 8.5 4 8.9 3 4.3
20-24 129 40.4 26 35.1 56 43.1 24 53.3 23 32.9
25-29 84 26.3 21 28.4 30 23.1 10 22.2 23 32.9
30-34 35 11.0 8 10.8 14 10.8 3 6.7 10 14.3
35-39 30 9.4 10 13.5 11 8.5 2 4.4 7 10.0
40-44 15 4.7 4 5.4 6 4.6 1 2.2 4 5.7
45-59 3 0.9 0 0.0 2 1.5 1 2.2 0 0.0
Race
American Indian/Alaska Native 7 2.2 1 1.4 1 0.8 2 4.4 3 4.3
Asian/Pacific Islander 20 6.3 7 9.5 6 4.6 4 8.9 3 4.3
Black/African American 33 10.3 5 6.8 19 14.6 1 2.2 8 11.4
White/Caucasian 243 76.2 54 73.0 103 79.2 36 80.0 50 71.4
Other/Unknown 16 5.0 7 9.5 1 0.8 2 4.4 6 8.6
Hispanic ethnicity
Yes 49 15.4 13 17.6 14 10.8 9 20.0 13 18.6
No 269 84.3 61 82.4 116 89.2 36 80.0 56 80.0
Unknown 1 0.3 0 0.0 0 0.0 0 0.0 1 1.4
Education
Less than high school 2 0.6 1 1.4 0 0.0 1 2.2 0 0.0
Alternative high school 21 6.6 0 0.0 15 11.5 0 0.0 6 8.6
High school graduate 225 70.5 45 60.8 90 69.2 42 93.3 48 68.6
Some college 38 11.9 15 20.3 15 11.5 1 2.2 7 10.0
4-year degree 25 7.8 9 12.2 8 6.2 1 2.2 7 10.0
Postgraduate 8 2.5 4 5.4 2 1.5 0 0.0 2 2.9
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Marital status
Never married 142 44.5 32 43.2 53 40.8 25 55.6 32 45.7
Married 159 49.8 35 47.3 73 56.2 20 44.4 31 44.3
Legally separated 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Divorced 18 5.6 7 9.5 4 3.1 0 0.0 7 10.0
Widowed 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Other/unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Rank/grade
Cadet/midshipman 1 0.3 0 0.0 1 0.8 0 0.0 0 0.0
E1-E4 157 49.2 31 41.9 72 55.4 26 57.8 28 40.0
E5-E9 138 43.3 36 48.6 50 38.5 17 37.8 35 50.0
Warrant officer 4 1.3 N/A N/A 3 2.3 1 2.2 0 0.0
Commissioned officer 19 6.0 7 9.5 4 3.1 1 2.2 7 10.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Continued on next page
20U.S. Joint Forces Calendar Year 2019 Annual Report
Table 12 (cont). Demographic characteristics, active-component suicide DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
DoD occupation group
Enlisted
Infantry, gun crews, and seamanship
specialists 58 18.2 1 1.4 44 33.8 9 20.0 4 5.7
Electronic equipment repairers 31 9.7 7 9.5 10 7.7 0 0.0 14 20.0
Communications and intelligence
specialists 30 9.4 6 8.1 16 12.3 5 11.1 3 4.3
Health care specialists 19 6.0 6 8.1 6 4.6 0 0.0 7 10.0
Other technical and allied specialists 13 4.1 4 5.4 5 3.8 2 4.4 2 2.9
Functional support and
administration 27 8.5 13 17.6 6 4.6 6 13.3 2 2.9
Electrical/mechanical equipment
repairers 58 18.2 16 21.6 16 12.3 8 17.8 18 25.7
Craftsworkers 12 3.8 2 2.7 5 3.8 1 2.2 4 5.7
Service and supply handlers 35 11.0 10 13.5 11 8.5 6 13.3 8 11.4
Non-occupational 10 3.1 2 2.7 1 0.8 6 13.3 1 1.4
Officer
General officers and executives 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Tactical operations officers 6 1.9 1 1.4 2 1.5 2 4.4 1 1.4
Intelligence officers 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Engineering and maintenance
officers 6 1.9 2 2.7 1 0.8 0 0.0 3 4.3
Scientists and professionals 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Health care officers 3 0.9 0 0.0 1 0.8 0 0.0 2 2.9
Administrators 4 1.3 0 0.0 3 2.3 0 0.0 1 1.4
Supply, procurement, and allied
officers 3 0.9 3 4.1 0 0.0 0 0.0 0 0.0
Non-occupational 2 0.6 1 1.4 1 0.8 0 0.0 0 0.0
Unknown 2 0.6 0 0.0 2 1.5 0 0.0 0 0.0
Number of deployments
0 179 56.1 29 39.2 78 60.0 33 73.3 39 55.7
1 46 14.4 14 18.9 18 13.8 3 6.7 11 15.7
2 40 12.5 8 10.8 15 11.5 7 15.6 10 14.3
3 or more 54 16.9 23 31.1 19 14.6 2 4.4 10 14.3
21U.S. Joint Forces Calendar Year 2019 Annual Report
Table 13. Demographic characteristics, active-component suicide-attempt DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Sex
Male 1009 69.0 314 64.7 339 72.3 203 77.8 153 61.9
Female 453 31.0 171 35.3 130 27.7 58 22.2 94 38.1
Age
17-19 214 14.6 56 11.5 89 19.0 53 20.3 16 6.5
20-24 813 55.6 254 52.4 233 49.7 169 64.8 157 63.6
25-29 260 17.8 105 21.6 83 17.7 24 9.2 48 19.4
30-34 100 6.8 37 7.6 36 7.7 10 3.8 17 6.9
35-39 55 3.8 27 5.6 18 3.8 4 1.5 6 2.4
40-44 13 0.9 3 0.6 7 1.5 1 0.4 2 0.8
45-59 7 0.5 3 0.6 3 0.6 0 0.0 1 0.4
Race
American Indian/Alaska Native 20 1.4 4 0.8 7 1.5 4 1.5 5 2.0
Asian/Pacific Islander 75 5.1 16 3.3 37 7.9 10 3.8 12 4.9
Black/African American 290 19.8 92 19.0 111 23.7 37 14.2 50 20.2
White/Caucasian 957 65.5 319 65.8 306 65.2 197 75.5 135 54.7
Other/Unknown 120 8.2 54 11.1 8 1.7 13 5.0 45 18.2
Hispanic ethnicity
Yes 194 13.3 92 19.0 40 8.5 23 8.8 39 15.8
No 1267 86.7 392 80.8 429 91.5 238 91.2 208 84.2
Unknown 1 0.1 1 0.2 0 0.0 0 0.0 0 0.0
Education
Less than high school 1 0.1 0 0.0 1 0.2 0 0.0 0 0.0
Alternative high school 70 4.8 0 0.0 48 10.2 8 3.1 14 5.7
High school graduate 1196 81.8 402 82.9 351 74.8 240 92.0 203 82.2
Some college 117 8.0 57 11.8 34 7.2 7 2.7 19 7.7
4-year degree 62 4.2 23 4.7 24 5.1 6 2.3 9 3.6
Postgraduate 15 1.0 3 0.6 10 2.1 0 0.0 2 0.8
Unknown 1 0.1 0 0.0 1 0.2 0 0.0 0 0.0
Marital status
Never married 851 58.2 259 53.4 285 60.8 178 68.2 129 52.2
Married 551 37.7 197 40.6 169 36.0 78 29.9 107 43.3
Legally separated 0 0.0
Divorced 59 4.0 29 6.0 14 3.0 5 1.9 11 4.5
Widowed 1 0.1 0 0.0 1 0.2 0 0.0 0 0.0
Other 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Rank/grade
Cadet/midshipman 3 0.2 3 0.6 0 0.0 0 0.0 0 0.0
E1-E4 1105 75.6 347 71.5 364 77.6 217 83.1 177 71.7
E5-E9 313 21.4 125 25.8 88 18.8 39 14.9 61 24.7
Warrant officer 6 0.4 N/A N/A 4 0.9 2 0.8 0 0.0
Commissioned officer 32 2.2 10 2.1 13 2.8 3 1.1 6 2.4
Unknown 3 0.2 0 0.0 0 0.0 0 0.0 3 1.2
Continued on next page
22U.S. Joint Forces Calendar Year 2019 Annual Report
Table 13 (cont). Demographic characteristics, active-component suicide-attempt DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
DoD occupation group
Enlisted
Infantry, gun crews, and seamanship
specialists 227 15.5 11 2.3 130 27.7 62 23.8 24 9.7
Electronic equipment repairers 109 7.5 40 8.2 18 3.8 11 4.2 40 16.2
Communications and intelligence
specialists 106 7.3 38 7.8 37 7.9 13 5.0 18 7.3
Health care specialists 131 9.0 49 10.1 55 11.7 1 0.4 26 10.5
Other technical and allied specialists 40 2.7 17 3.5 14 3.0 9 3.4 0 0.0
Functional support and
administration 203 13.9 75 15.5 60 12.8 48 18.4 20 8.1
Electrical/mechanical equipment
repairers 309 21.1 132 27.2 55 11.7 49 18.8 73 29.6
Craftsworkers 43 2.9 15 3.1 11 2.3 12 4.6 5 2.0
Service and supply handlers 185 12.7 62 12.8 70 14.9 28 10.7 25 10.1
Non-occupational 67 4.6 33 6.8 1 0.2 23 8.8 10 4.0
Officer
General officers and executives 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Tactical operations officers 11 0.8 4 0.8 3 0.6 3 1.1 1 0.4
Intelligence officers 5 0.3 1 0.2 2 0.4 1 0.4 1 0.4
Engineering and maintenance
officers 4 0.3 0 0.0 4 0.9 0 0.0 0 0.0
Scientists and professionals 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Health care officers 10 0.7 4 0.8 4 0.9 0 0.0 2 0.8
Administrators 5 0.3 1 0.2 2 0.4 0 0.0 2 0.8
Supply, procurement, and allied
officers 2 0.1 0 0.0 1 0.2 1 0.4 0 0.0
Non-occupational 4 0.3 3 0.6 1 0.2 0 0.0 0 0.0
Unknown 1 0.1 0 0.0 1 0.2 0 0.0 0 0.0
Number of deployments
0 1052 72.0 308 63.5 354 75.5 224 85.8 166 67.2
1 214 14.6 79 16.3 61 13.0 18 6.9 56 22.7
2 93 6.4 45 9.3 23 4.9 8 3.1 17 6.9
3 or more 103 7.0 53 10.9 31 6.6 11 4.2 8 3.2
23U.S. Joint Forces Calendar Year 2019 Annual Report
Table 14. Event characteristics, active-component suicide DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Event location country
United States 283 88.7 66 89.2 116 89.2 41 91.1 60 85.7
Korea 4 1.3 0 0.0 3 2.3 1 2.2 0 0.0
Japan 11 3.4 3 4.1 1 0.8 2 4.4 5 7.1
Germany 4 1.3 1 1.4 3 2.3 0 0.0 0 0.0
United Kingdom 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Other 15 4.7 3 4.1 6 4.6 1 2.2 5 7.1
Unknown 2 0.6 1 1.4 1 0.8 0 0.0 0 0.0
Event setting
Own residence 140 43.9 41 55.4 52 40.0 17 37.8 30 42.9
Barracks 57 17.9 12 16.2 27 20.8 14 31.1 4 5.7
Residence of friend or family 24 7.5 3 4.1 10 7.7 4 8.9 7 10.0
Work/jobsite 16 5.0 1 1.4 6 4.6 3 6.7 6 8.6
Automobile 30 9.4 5 6.8 15 11.5 1 2.2 9 12.9
Inpatient medical facility 1 0.3 0 0.0 0 0.0 0 0.0 1 1.4
Hotel 9 2.8 1 1.4 3 2.3 1 2.2 4 5.7
Other 41 12.9 10 13.5 17 13.1 5 11.1 9 12.9
Unknown 1 0.3 1 1.4 0 0.0 0 0.0 0 0.0
Method of injury
Drug/alcohol 7 2.2 2 2.7 0 0.0 2 4.4 3 4.3
Hanging/asphyxiation 96 30.1 19 25.7 45 34.6 13 28.9 19 27.1
Poison 13 4.1 5 6.8 5 3.8 2 4.4 1 1.4
Firearm 191 59.9 46 62.2 76 58.5 26 57.8 43 61.4
Military issued 19 6.0 2 2.7 9 6.9 3 6.7 5 7.1
Personally owned 167 52.4 44 59.5 64 49.2 21 46.7 38 54.3
Of unknown provenance 5 1.6 0 0.0 3 2.3 2 4.4 0 0.0
Trauma 12 3.8 2 2.7 4 3.1 2 4.4 4 5.7
Other 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Alcohol used during event
Yes 88 27.6 22 29.7 28 21.5 12 26.7 26 37.1
No 127 39.8 29 39.2 60 46.2 18 40.0 20 28.6
Unknown 104 32.6 23 31.1 42 32.3 15 33.3 24 34.3
Drugs used during event
Yesa 22 6.9 7 9.5 3 2.3 3 6.7 9 12.9
Drugs (illicit/illegal)
Used, overdose 2 0.6 1 1.4 0 0.0 1 2.2 0 0.0
Used, no overdose 4 1.3 0 0.0 1 0.8 1 2.2 2 2.9
Prescription medications
Used, overdose 5 1.6 1 1.4 1 0.8 1 2.2 2 2.9
Used, no overdose 10 3.1 4 5.4 2 1.5 0 0.0 4 5.7
Non-prescription medications
Used, overdose 7 2.2 4 5.4 0 0.0 2 4.4 1 1.4
Used, no overdose 4 1.3 2 2.7 0 0.0 1 2.2 1 1.4
No 176 55.2 37 50.0 84 64.6 21 46.7 34 48.6
Unknown 121 37.9 30 40.5 43 33.1 21 46.7 27 38.6
Continued on next page
24U.S. Joint Forces Calendar Year 2019 Annual Report
Table 14 (cont). Event characteristics, active-component suicide DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Communicated intent for self-harm
Yesa 108 33.9 24 32.4 35 26.9 18 40.0 31 44.3
Spouse 42 13.2 12 16.2 13 10.0 5 11.1 12 17.1
Friend 37 11.6 7 9.5 11 8.5 7 15.6 12 17.1
Mental health staff 23 7.2 4 5.4 5 3.8 5 11.1 9 12.9
No/no known history 211 66.1 50 67.6 95 73.1 27 60.0 39 55.7
Is there evidence the event involved
death-risk gambling?
Yes 7 2.2 1 1.4 3 2.3 2 4.4 1 1.4
No 281 88.1 58 78.4 116 89.2 43 95.6 64 91.4
Unknown 31 9.7 15 20.3 11 8.5 0 0.0 5 7.1
Is there evidence the event was planned
and/or premeditated?
Yes 121 37.9 28 37.8 50 38.5 20 44.4 23 32.9
No 133 41.7 26 35.1 60 46.2 14 31.1 33 47.1
Unknown 65 20.4 20 27.0 20 15.4 11 24.4 14 20.0
Event observable
Yes 64 20.1 18 24.3 28 21.5 4 8.9 14 20.0
No 247 77.4 52 70.3 98 75.4 41 91.1 56 80.0
Unknown 8 2.5 4 5.4 4 3.1 0 0.0 0 0.0
Left a suicide note
Yes 76 23.8 21 28.4 23 17.7 10 22.2 22 31.4
No 207 64.9 42 56.8 93 71.5 29 64.4 43 61.4
Unknown 36 11.3 11 14.9 14 10.8 6 13.3 5 7.1
Residence at time of event
Barracks 85 26.6 11 14.9 43 33.1 17 37.8 14 20.0
BEQ/BOQ 17 5.3 3 4.1 5 3.8 6 13.3 3 4.3
On-base family housing 36 11.3 12 16.2 16 12.3 5 11.1 3 4.3
Off-base 158 49.5 47 63.5 54 41.5 17 37.8 40 57.1
Ship 5 1.6 0 0.0 0 0.0 0 0.0 5 7.1
Other 17 5.3 0 0.0 12 9.2 0 0.0 5 7.1
Unknown 1 0.3 1 1.4 0 0.0 0 0.0 0 0.0
Resided alone at time of event
Yes 115 35.8 31 41.9 49 37.7 13 28.9 22 31.4
No 191 59.5 37 50.0 74 56.9 32 71.1 48 68.6
Children resided with Service
member 53 16.5 14 18.9 18 13.8 8 17.8 13 18.6
Unknown 13 4.0 6 8.1 7 5.4 0 0.0 0 0.0
Gun in home/immediate environment
Yes 186 58.3 45 60.8 74 56.9 25 55.6 42 60.0
No 109 34.2 20 27.0 47 36.2 18 40.0 24 34.3
Unknown 24 7.5 9 12.2 9 6.9 2 4.4 4 5.7
Duty environmenta
Permanent command/garrison 235 73.7 57 77.0 102 78.5 34 75.6 42 60.0
Leave 25 7.8 2 2.7 13 10.0 3 6.7 7 10.0
Temporary duty assignment 12 3.8 2 2.7 3 2.3 5 11.1 2 2.9
Deployed 9 2.8 1 1.4 4 3.1 0 0.0 4 5.7
Training 15 4.7 3 4.1 4 3.1 4 8.9 4 5.7
Other 38 11.9 8 10.8 9 6.9 5 11.1 16 22.9
a
Subcategories are not mutually exclusive.
25U.S. Joint Forces Calendar Year 2019 Annual Report
Table 15. Event characteristics, active-component suicide-attempt DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Event location country
United States 1148 78.5 368 75.9 375 80.0 205 78.5 200 81.0
Korea 38 2.6 16 3.3 20 4.3 2 0.8 0 0.0
Japan 63 4.3 24 4.9 7 1.5 25 9.6 7 2.8
Germany 43 2.9 29 6.0 14 3.0 0 0.0 0 0.0
United Kingdom 17 1.2 17 3.5 0 0.0 0 0.0 0 0.0
Other 49 3.4 23 4.7 14 3.0 4 1.5 8 3.2
Unknown 104 7.1 8 1.6 39 8.3 25 9.6 32 13.0
Event setting
Own residence 513 35.1 229 47.2 130 27.7 53 20.3 101 40.9
Barracks 616 42.1 143 29.5 252 53.7 165 63.2 56 22.7
Residence of friend or family 76 5.2 29 6.0 10 2.1 13 5.0 24 9.7
Work/jobsite 48 3.3 13 2.7 10 2.1 6 2.3 19 7.7
Automobile 92 6.3 34 7.0 29 6.2 10 3.8 19 7.7
Inpatient medical facility 11 0.8 5 1.0 3 0.6 2 0.8 1 0.4
Hotel 15 1.0 7 1.4 4 0.9 0 0.0 4 1.6
Other 77 5.3 23 4.7 20 4.3 12 4.6 22 8.9
Unknown 14 1.0 2 0.4 11 2.3 0 0.0 1 0.4
Method of injury
Drug/alcohol 776 53.1 238 49.1 260 55.4 133 51.0 145 58.7
Hanging/asphyxiation 226 15.5 84 17.3 66 14.1 53 20.3 23 9.3
Poison 54 3.7 18 3.7 27 5.8 5 1.9 4 1.6
Firearm 75 5.1 31 6.4 20 4.3 10 3.8 14 5.7
Military issued 11 0.8 3 0.6 4 0.9 3 1.1 1 0.4
Personally owned 64 4.4 28 5.8 16 3.4 7 2.7 13 5.3
Of unknown provenance 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Trauma 283 19.4 97 20.0 70 14.9 58 22.2 58 23.5
Other 24 1.6 12 2.5 9 1.9 1 0.4 2 0.8
Unknown 24 1.6 5 1.0 17 3.6 1 0.4 1 0.4
Alcohol used during event
Yes 455 31.1 169 34.8 141 30.1 83 31.8 62 25.1
No 967 66.1 305 62.9 311 66.3 171 65.5 180 72.9
Unknown 40 2.7 11 2.3 17 3.6 7 2.7 5 2.0
Drugs used during event
Yesa 694 47.5 210 43.3 213 45.4 125 47.9 146 59.1
Drugs (illicit/illegal)
Used, overdose 54 3.7 19 3.9 19 4.1 4 1.5 12 4.9
Used, no overdose 22 1.5 6 1.2 5 1.1 2 0.8 9 3.6
Prescription medications
Used, overdose 353 24.1 98 20.2 122 26.0 63 24.1 70 28.3
Used, no overdose 72 4.9 38 7.8 20 4.3 4 1.5 10 4.0
Non-prescription medications
Used, overdose 274 18.7 58 12.0 81 17.3 64 24.5 71 28.7
Used, no overdose 66 4.5 29 6.0 17 3.6 6 2.3 14 5.7
No 729 49.9 262 54.0 238 50.7 131 50.2 98 39.7
Unknown 39 2.7 13 2.7 18 3.8 5 1.9 3 1.2
Continued on next page
26U.S. Joint Forces Calendar Year 2019 Annual Report
Table 15 (cont). Event characteristics, active-component suicide-attempt DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Communicated intent for self-harm
Yesa 340 23.3 124 25.6 117 24.9 38 14.6 61 24.7
Spouse 92 6.3 34 7.0 37 7.9 12 4.6 9 3.6
Friend 136 9.3 52 10.7 42 9.0 13 5.0 29 11.7
Mental health staff 65 4.4 26 5.4 14 3.0 7 2.7 18 7.3
No/no known history 1106 75.6 359 74.0 341 72.7 221 84.7 185 74.9
Unknown 16 1.1 2 0.4 11 2.3 2 0.8 1 0.4
Is there evidence the event involved
death-risk gambling?
Yes 94 6.4 39 8.0 34 7.2 12 4.6 9 3.6
No 1302 89.1 417 86.0 413 88.1 240 92.0 232 93.9
Unknown 66 4.5 29 6.0 22 4.7 9 3.4 6 2.4
Is there evidence the event was planned
and/or premeditated?
Yes 413 28.2 130 26.8 106 22.6 104 39.8 73 29.6
No 977 66.8 330 68.0 336 71.6 150 57.5 161 65.2
Unknown 72 4.9 25 5.2 27 5.8 7 2.7 13 5.3
Event observable
Yes 542 37.1 181 37.3 182 38.8 91 34.9 88 35.6
No 883 60.4 295 60.8 268 57.1 164 62.8 156 63.2
Unknown 37 2.5 9 1.9 19 4.1 6 2.3 3 1.2
Left a suicide note
Yes 193 13.2 67 13.8 61 13.0 26 10.0 39 15.8
No 1238 84.7 410 84.5 394 84.0 230 88.1 204 82.6
Unknown 31 2.1 8 1.6 14 3.0 5 1.9 4 1.6
Residence at time of event
Barracks 707 48.4 163 33.6 289 61.6 187 71.6 68 27.5
BEQ/BOQ 13 0.9 7 1.4 1 0.2 2 0.8 3 1.2
On-base family housing 132 9.0 55 11.3 53 11.3 11 4.2 13 5.3
Off-base 529 36.2 236 48.7 108 23.0 52 19.9 133 53.8
Ship 23 1.6 0 0.0 0 0.0 1 0.4 22 8.9
Other 46 3.1 22 4.5 14 3.0 5 1.9 5 2.0
Unknown 12 0.8 2 0.4 4 0.9 3 1.1 3 1.2
Resided alone at time of event
Yes 525 35.9 233 48.0 156 33.3 62 23.8 74 30.0
No 912 62.4 243 50.1 306 65.2 195 74.7 168 68.0
Children resided with Service
member 154 10.5 65 13.4 45 9.6 17 6.5 27 10.9
Unknown 25 1.7 9 1.9 7 1.5 4 1.5 5 2.0
Gun in home/immediate environment
Yes 151 10.3 60 12.4 52 11.1 15 5.7 24 9.7
No 1269 86.8 415 85.6 400 85.3 240 92.0 214 86.6
Unknown 42 2.9 10 2.1 17 3.6 6 2.3 9 3.6
Duty environmenta
Permanent command/garrison 1066 72.9 382 78.8 320 68.2 192 73.6 172 69.6
Leave 35 2.4 16 3.3 9 1.9 7 2.7 3 1.2
Temporary duty assignment 22 1.5 9 1.9 3 0.6 5 1.9 5 2.0
Deployed 32 2.2 11 2.3 13 2.8 1 0.4 7 2.8
Training 104 7.1 20 4.1 60 12.8 18 6.9 6 2.4
Other 138 9.4 56 11.5 24 5.1 19 7.3 39 15.8
a
Subcategories are not mutually exclusive.
27U.S. Joint Forces Calendar Year 2019 Annual Report
Table 16. Physical and mental health characteristics, active-component suicide DoDSER forms, CY19
Total Air Force Army Marine Corps Navy
No. % No. % No. % No. % No. %
Any mental health diagnosis
Yesa 139 43.6 35 47.3 63 48.5 15 33.3 26 37.1
Mood 57 17.9 12 16.2 27 20.8 5 11.1 13 18.6
Anxiety 46 14.4 11 14.9 18 13.8 5 11.1 12 17.1
Adjustment 57 17.9 17 23.0 26 20.0 5 11.1 9 12.9
Substance use 66 20.7 11 14.9 35 26.9 7 15.6 13 18.6
No/no known history 180 56.4 39 52.7 67 51.5 30 66.7 44 62.9
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
History of sleep disorder
Yes 38 11.9 7 9.5 20 15.4 3 6.7 8 11.4
No/no known history 281 88.1 67 90.5 110 84.6 42 93.3 62 88.6
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
History of traumatic brain injury
Yes 6 1.9 0 0.0 4 3.1 1 2.2 1 1.4
No/no known history 100.
313 98.1 74 0 126 96.9 44 97.8 69 98.6
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Family history of mental illness
Yes 32 10.0 7 9.5 20 15.4 0 0.0 5 7.1
No/no known history 287 90.0 67 90.5 110 84.6 45 100.0 65 92.9
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Prior self-harm
Yes 32 10.0 5 6.8 12 9.2 4 8.9 11 15.7
One prior event 18 5.6 2 2.7 3 2.3 3 6.7 10 14.3
More than one prior event 14 4.4 3 4.1 9 6.9 1 2.2 1 1.4
Most recent event similar to current
event 7 2.2 0 0.0 3 2.3 2 4.4 2 2.9
No/no known history 287 90.0 69 93.2 118 90.8 41 91.1 59 84.3
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
History of psychotropic medication use
Yes 69 21.6 17 23.0 31 23.8 7 15.6 14 20.0
No/no known history 250 78.4 57 77.0 99 76.2 38 84.4 56 80.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Use of psychotropic medications, last 90
days
Yesa 49 15.4 12 16.2 22 16.9 5 11.1 10 14.3
Antidepressants 45 14.1 10 13.5 21 16.2 5 11.1 9 12.9
Anxiolytics 23 7.2 7 9.5 9 6.9 2 4.4 5 7.1
Antimanic 3 0.9 0 0.0 3 2.3 0 0.0 0 0.0
Anticonvulsant 3 0.9 2 2.7 1 0.8 0 0.0 0 0.0
Antipsychotic 1 0.3 1 1.4 0 0.0 0 0.0 0 0.0
Sleep medication 20 6.3 5 6.8 11 8.5 1 2.2 3 4.3
No/no known history 270 84.6 62 83.8 108 83.1 40 88.9 60 85.7
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28U.S. Joint Forces Calendar Year 2019 Annual Report
Table 16 (cont). Physical and mental health characteristics, active-component suicide DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Pain medication use at time of event
Yes 32 10.0 10 13.5 11 8.5 4 8.9 7 10.0
Opioid medication 4 1.3 0 0.0 1 0.8 1 2.2 2 2.9
No/no known history 287 90.0 64 86.5 119 91.5 41 91.1 63 90.0
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Health/social services, last 90 days
Yesa 167 52.4 44 59.5 72 55.4 20 44.4 31 44.3
Medical treatment facility 146 45.8 41 55.4 63 48.5 17 37.8 25 35.7
Substance abuse services 29 9.1 4 5.4 15 11.5 4 8.9 6 8.6
Family assistance program 15 4.7 6 8.1 8 6.2 1 2.2 0 0.0
Mental healtha 102 32.0 22 29.7 51 39.2 9 20.0 20 28.6
Outpatient 100 31.3 22 29.7 51 39.2 7 15.6 20 28.6
Inpatient 20 6.3 4 5.4 11 8.5 3 6.7 2 2.9
No/no known history 152 47.6 30 40.5 58 44.6 25 55.6 39 55.7
Unknown 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
a
Subcategories are not mutually exclusive.
29U.S. Joint Forces Calendar Year 2019 Annual Report
Table 17. Physical and mental health characteristics, active-component suicide-attempt DoDSER forms, CY19
Total Air Force Army Marine Navy
Corps
No. % No. % No. % No. % No. %
Any mental health diagnosis
Yesa 838 57.3 288 59.4 249 53.1 139 53.3 162 65.6
Mood 434 29.7 153 31.5 128 27.3 65 24.9 88 35.6
Anxiety 315 21.5 111 22.9 94 20.0 50 19.2 60 24.3
Adjustment 306 20.9 118 24.3 97 20.7 37 14.2 54 21.9
Substance use 316 21.6 75 15.5 116 24.7 67 25.7 58 23.5
No/no known history 611 41.8 196 40.4 209 44.6 122 46.7 84 34.0
Unknown 13 0.9 1 0.2 11 2.3 0 0.0 1 0.4
History of sleep disorder
Yes 103 7.0 29 6.0 46 9.8 9 3.4 19 7.7
No/no known history 1346 92.1 455 93.8 412 87.8 252 96.6 227 91.9
Unknown 13 0.9 1 0.2 11 2.3 0 0.0 1 0.4
History of traumatic brain injury
Yes 61 4.2 10 2.1 23 4.9 13 5.0 15 6.1
No/no known history 1388 94.9 474 97.7 435 92.8 248 95.0 231 93.5
Unknown 13 0.9 1 0.2 11 2.3 0 0.0 1 0.4
Family history of mental illness
Yes 512 35.0 185 38.1 161 34.3 65 24.9 101 40.9
No/no known history 937 64.1 299 61.6 297 63.3 196 75.1 145 58.7
Unknown 13 0.9 1 0.2 11 2.3 0 0.0 1 0.4
Prior self-harm
Yes 440 30.1 138 28.5 151 32.2 72 27.6 79 32.0
One prior event 205 14.0 67 13.8 61 13.0 33 12.6 44 17.8
More than one prior event 229 15.7 71 14.6 84 17.9 39 14.9 35 14.2
Most recent event similar to current
event 205 14.0 63 13.0 70 14.9 36 13.8 36 14.6
No/no known history 1008 68.9 345 71.1 307 65.5 189 72.4 167 67.6
Unknown 14 1.0 2 0.4 11 2.3 0 0.0 1 0.4
History of psychotropic medication use
Yes 476 32.6 189 39.0 137 29.2 69 26.4 81 32.8
No/no known history 972 66.5 295 60.8 321 68.4 191 73.2 165 66.8
Unknown 14 1.0 1 0.2 11 2.3 1 0.4 1 0.4
Use of psychotropic medications, last 90
days
Yesa 394 26.9 151 31.1 115 24.5 57 21.8 71 28.7
Antidepressants 351 24.0 141 29.1 99 21.1 47 18.0 64 25.9
Anxiolytics 159 10.9 56 11.5 50 10.7 26 10.0 27 10.9
Antimanic 14 1.0 10 2.1 3 0.6 1 0.4 0 0.0
Anticonvulsant 10 0.7 3 0.6 3 0.6 2 0.8 2 0.8
Antipsychotic 36 2.5 16 3.3 11 2.3 7 2.7 2 0.8
Sleep medication 183 12.5 77 15.9 64 13.6 19 7.3 23 9.3
No/no known history 1054 72.1 333 68.7 343 73.1 203 77.8 175 70.9
Unknown 14 1.0 1 0.2 11 2.3 1 0.4 1 0.4
Continued on next page
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